RA 


/\    ^  Z-       -y-^u^A^  ssttp. 


MORTALITY  REPORT 

OF  THE 

GiFT 
J  AN  23 1928 

TENNESSEE  STA  TE  BOARD 

OF  HEALTH 

LiBRARV 

U-      ■ 

0 

1915 

^Y 


.<A 


^^^  o    Z-       T&v^Messe 


MEMBERS  OF  THE  BOARD. 

R.  E.  FORT,  M.D Nashville 

President 

W.   J.   MILLER,  M.D Johnson  City 

Vke-Presideiil 

V.  A.  BIGGS,  M.D. Martin 

HON.    H.    K.    BRYSON Fayettev-ille 


OFFICERS. 

R.  Q.  LILLARD,  M.D Lebanon 

Secretary  and  Executive  Officer 

H.  H.  SHOLT.DERS.  M.D Nash\-ille 

State  Registrar  of  Vital  Statistics 

OLIN  WEST,  M.D Nash\'iile 

State  Director  of  Rural  Sanitation 

WILLL\]SI  LITTERER,  M.D Nashville 

State  Bacteriologist 

HARRY    L.    ESKEW Nashville 

Commissioner  Pure  Food  and  Drugs  Department 


646233 


Mortality  Report  of  the  Tennessee  State 
Board  of  Health. 

Mortality  statistics  have  two  very  important  sanitary  purposes  to  serve: — one 
bciog  that  of  ^tirniujating  the  unit  of  society  to  a  consciousness  of  its  conditions 
with  reference  to  the  causes  which  bring  about  preventable  deaths;  the  other  that 
of  directing  efforts  devoted  to  the  correction  of  the  conditions  at  fault. 

This  short  bulletin  contains  a  report  in  brief  of  the  number  of  deaths  from  several 
preventable  causes,  together  with  the  death  rate  of  each  per  100,000  population 
for  the  year  1916. 

From  a  careful  review  of  the  data  here  presented  the  reader  may  form  a  definite 
idea  of  the  conditions  which  prevail  in  Tennessee  with  respect  to  these  fimdamental 
affairs. 

TABLE  NO.  1. 

Showing  the  number  of  deaths  in  the  State  and  its  death  rate  per  100,000  popu- 
lation from  each  of  several  causes,  with  color  divisions  in  tuberculosis  and  pel- 
lagra. The  rates  given  are  based  upon  the  United  States  Census  estimate  of  the 
population  of  the  State  for  1915 — except  when  otherwise  indicated. 

Tuberculosis  (.\11  Forms) .. 4,499  193. 1 

White 2,656        *lo5!2 

,    .    ,T>9°'°''^<^ 1'843  MOo.o 

Tuberculoeia  (Pulmonars') _  4085  179  8 

Wtite.-". 2'.406  *14o'.6 

Colored 1,679  •354.9 

TuberciJosis  (All  Other  Forms) 414  18  2 

White 2.50  '14!  6 

Colored 164  *34.9 

Pneumonia  (Lobar  and  Broncho) 2,451  107.8 

Cancer  (Including  All  Forms  of  Malignant  Tiunors 775  34!  1 

Typhoid  Fever  (Including  Para-Typhoid) 906  39.8 

Malaria 49I  2I.6 

Pellagra 834  36  7 

White.. 464  •27.1 

Colored 370  *78.2 

Measles 22  0.9 

Whooping  Cough 157  6!9 

Scarlet  Fever 33  1.4 

Diphtheria  and  Ooup 489  21.5 

Inlluecza 398  17!  5 

Cerebro-Spiaal  Meningitis 139  6.1 

Diarrhea  and  Enteritis  (under  2  years  of  age) 1,107  49.4 

Puerperal  Conditions  (Total) .324  14.2 

Puerperal  Septicaemia 161  7.0 

Puerperal  ((Donditiona  other  tiian  Septicaemia) 163  7.1 

Homicides 400  17.6 

Suicides I54  §^7 

Piaiboad  Accidents  (All  Forms) 132  5.8 

Automobile  Accidents 31  1.3 

Accideut3  (All  (Jther) 727  32.0 

Smallpox 42  i.g 

14,116 
•As  per  Census  1910. 

To  report  in  great  detail  on  each  preventable  disease  mentioned  in  Table  No.  1 
would  require  more  space  than  is  available  in  a  short  bulletin.  We  have  there- 
fore chosen  to  report  in  detail  on  only  five,  viz.,  Tuberculosis,  Tj^jhoid  Fever, 
Pellagra,  Diarrhea  and  Enteritis  of  Infants  under  2  years  of  age  and  Malaria. 
These  diseases  constitute  the  major  causes  of  preventable  deaths  and  therefore 
offer  the  greatest  hindrance  to  the  progress  of  the  State. 

—4^ 


TUBERCULOSIS 

In  Table  No.  2  will  be  found  the  number  of  deaths  from  tuberculosis,  grouped 
according  to  color  of  decedent  and  according  to  the  form  of  the  disease,  in  each 
county  of  the  State,  together  vi-ith  the  death  rate  of  each,  and  the  per  cent  of  the 
total  number  of  deaths  of  each  due  to  tuberculosis.  This  is  to  enable  a  com- 
parison of  the  tuberculosis  death  rate  of  the  State,  and  the  rate  of  any  county  or 
city  of  the  State,  with  that  of  any  other  county  in  Tennessee,  and  with  the  rates 
of  the  States  given  in  Table  No.  3. 

From  the  per  cent  of  all  deaths  due  to  tuberculosis  the  reader  is  enabled  to  de- 
termine the  relative  importance  of  tuberculosis  as  a  cause  of  death.  If  20  per 
cent  of  the  deaths  of  a  county  were  due  to  tuberculosis,  one  out  of  every  five  deaths 
in  the  county  was  due  to  tuberculosis. 

Bearing  in  mind  that  it  is  by  comparison  that  we  determine  our  relationships 
with  the  world  about  us,  we  present  in  Table  No.  3  the  tuberculosis  death  rate  of 
each  of  several  States  to  enable  the  reader  to  determine  the  relationship  which 
obtains  between  Teimessee  and  those  States  with  respect  to  this  major  health 
problem. 

From  the  data  here  presented  we  may  get  a  very  broad  view  of  the  tuberculosis 
problem  as  it  exists  today  in  Tennessee.  Broadly  speaking,  we  may  saj'  that  the 
fundamental  causes  of  the  disease  are  more  effective,  or  that  the  fundamental 
defects,  both  indi\ddual  and  general,  which  bring  about  tuberculosis,  are  present 
in  Tennessee  to  a  more  marked  degree  than  in  most  other  States. 

We  would  call  particular  attention  to  the  difference  in  the  White  and  Colored 
tuberculosis  death  rates  in  Tennessee.  This  difference  is  very  striking,  and  in- 
dicates that  the  influences  which  cause  tuberculosis  predominate  among  the 
colored  race. 

It  would  be  improper  to  think  that  these  4,499  persons  contracted  tuberculosis 
and  died  of  the  disease  in  one  year.  These  deaths,  in  a  majority  of  cases,  marked 
the  ending  of  a  long  fight,  in  which  the  disease  was  conqueror.  There  are  now 
as  many  more  persons  in  Tennessee  who  are  in  the  advanced  stages  of  the  disease, 
who  will  die  in  1916,  and  as  many  more  doomed  to  the  same  fate  in  1917,  which 
means  that  on  January  1st,  1916,  there  existed  in  Tennessee  9,000  persons  with 
the  disease   (tuberculosis)  sufficiently  advanced  as  to  prove  fatal  within  two  years. 

It  would  be  impossible  to  determine  accurately  the  number  of  moderately  ad- 
vanced and  incipient  cases  existing.  It  would  be  reasonable  to  assume^  however, 
that  there  are  ten  of  such  cases  for  each  death  that  has  occurred  in  one  year,  which 
would  mean  that  our  mortality  records  indicate  that  there  are  now  in  the  State 
44,990  persons  with  a  lesion  of  tuberculosis,  of  which  the  individual  may,  or  may 
not  be,  aware.  The  tuberculosis  process  in  these  cases  may  be  arrested,  or  be 
permitted  to  advance,  depending  upon  the  resistance  of  the  individual. 

The  average  age  at  death  from  tuberculosis  is  34  years.  At  least,  one  half  of 
all  the  persons  who  died  of  the  disease  were  either  fathers  or  mothers.  They  have 
left  the  orphan  handicapped  by  a  hereditary  predisposition  to  the  disease;  with 
the  infection  in  their  systems  as  a  result  of  intimate  contact,  and  in  many  in- 
stances in  poverty  as  a  result  of  the  prolonged  illness  in  the  home.  A  large  num- 
ber of  these  orphans  as  a  result  of  all  these  circumstances  will  join  the  throng  of 
advanced  cases  as  the  years  go  by. 

—5— 


There  are  many  other  visions  of  the  tuberculosis  situation  one  may  get  by  a 
careful  analysis  of  the  data — a  vision  which  would  lead  one  to  recognize  that  the 
combined  influences  which  bring  about  the  development  of  the  advanced  case  of 
tuberculosis  are  cumulative  in  their  action,  and  that  some  of  them  are  so  broad 
and  so  far  reaching  as  to  link  the  dead  to  the  unborn. 

TABLE  NO.  2 

Showing  the  number  of  deaths  from  Tuberculosis,  in  its  various  forms,  in  each 
county  and  city  in  the  State,  together  with  the  death  rate  of  each  per  100,000 
population. 


Anderson 

Bedford 

Benton 

Bledsoe 

Blount 

Bradley- 

Campbell 

Cannon 

Carroll 

Carter 

Cheatham 

Chester 

Claiborne 

Clay 

Cocke 

Coffee 

Crockett 

Cumberland— 

*Da\idson 

Nashville 

Decatur 

DeKalb 

Dickson 

Djer 

Fayette 

Fentress 

Franklin 

Gibson 

Giles 

Grainger 

Greene 

Grundy 

Hamblen 

'Hamilton 

Chattanooga. 

Hancocke 

Hardeman 

Hardin 

Hawkins 

Haywood 

Henderson. -- 

Henry -. 

Hickinan 

Houston 

Humphreys.. 

Jackson 

James 

Jefferson 

Johnson 

*Kcox 

Knoiville — 

Lake 

Lauderdale.. 

Lawrence 

Lewis 

Lincoln 

Loudon 

Macon 

McMinn 

McKairy... 


Pulmonary 
Tuberculosis 


WTiite    i  Colored 


26 
25 
12 

4 
23 
25 
21 
26 
41 
23 
14 
12 
15 
13 
2J> 
26 
14 

6 


1 
1 

2 

5 
12 

0 
60 
14S 

6 

S 
24 
55 

0 
15 
43 
4& 


Tuberculosis 
Ml  Other  Forms 


White      Colored 


10 
3 
2 
0 
2 

i 

0 
0 
3 
4 
2 
1 
2 
1 
4 
0 
0 
1 
6 

20 
1 
1 
3 
2 
0 
0 
1 
3 
6 
0 
8 
C 
0 
6 
7 
0 
1 
1 
3 
4 
1 
4 
0 
0 
2 

2 
0 
0 
2 
6 
6 
0 
0 

0 
5 
1 
2 
2 
2 


0 
1 
0 
0 

1 

0 
0 
0 

1 

0 
0 
0 
0 
10 
0 
0 

1 
1 

4 
18 

0 

1 
1 

2 
5 
0 
0 
5 
6 
0 
1 
0 
2 
5 
13 
0 
1 
1 
0 
3 
2 
4 
0 
1 
0 
0 
0 

1 

0 

1 

4 
0 
0 
0 
0 
1 
0 
0 
0 
0 


Total 

No. 

Deaths 


28 
37 
25 
29 
61 
28 
22 
19 
18 
151 
34 
31 
27 
8 
128 
273 
15 
17 
39 
51 
63 

4 

36 
87 
101 
27 
56 

6 
31 
104 
129 
10 
49 
21 
41 
79 
26 
39 
24 
12 
27 

9 

5 

26 
14 
110 

as 

3 

46 
36 
11 
52 
22 
24 
34 
22 


Death 
Rate  Per 

100,000 
Populate 


Percent 
of  Total 
Deaths 


146 

15 

243 

18 

110 

9 

96 

8.6 

129 

10 

223 

13 

76 

9 

268 

19 

255 

17 

128 

9 

205 

18 

211 

18 

72 

10 

161 

23 

174 

14 

198 

15 

167 

12 

81 

12 

279 

17 

244 

12 

150 

17 

110 

9 

189 

16 

171 

12 

206 

13 

49 

7 

175 

15 

200 

15 

309 

23 

195 

14 

178 

15 

70 

13 

134 

11 

230 

13 

220 

11 

93 

10 

212 

12 

120 

18 

175 

16 

301 

16 

147 

14 

150 

15 

138 

19 

193 

17 

191 

19 

60 

6 

96 

9 

147 

12 

93 

11 

166 

12 

233 

12 

32 

5 

218 

14 

192 

20 

161 

14 

200 

17 

146 

12 

156 

15 

154 

9 

135 

13 

—6— 


•Madison.. - 

Jackson 

Marion 

Marshall 

Maury 

MeigB 

Monroe 

Montgomery 

Moore 

Morgan 

Obion 

Overton 

Perry 

Pickett 

Polk 

Putnam 

Rhea 

Roane 

Robertaon... 
Rutherford.. 
Scott........ 

Sequatchie.. 

Sevier 

'Shelby 

Memphis 

Smith 

Stewart 

Sulli'/an 

Simmer 

Tipton 

Trousdale 

Unicoi 

Union 

VanBuren... 

Warren 

Washington - 

Wayne 

Weakley 

White 

Williamson.. 
Wilson 


Pulmr 

narv 

Tuberculosis 

Beath 

Tuberculosis 

AH  Other  Forms 

Total 

ilate  Per 

No. 
Deaths 

100,000 
i'opulatn 

White 

Colored 

White 

Colored 

18 

22 

0 

2 

42 

181 

16 

21 

■i 

1 

40 

226 

16 

10 

1 

0 

27 

137 

28 

8 

3 

1 

40 

232 

33 

48 

3 

4 

88 

215 

7 

1 

0 

0 

8 

131 

31 

6 

0 

2 

39 

178 

41 

55 

7 

1 

104 

309 

10 

1 

0 

0 

11 

229 

15 

1 

0 

0 

16 

129 

30 

14 

4 

2 

50 

162 

33 

0 

2 

0 

35 

204 

17 

0 

0 

0 

17 

193 

4 

0 

0 

0 

4 

80 

6 

0 

0 

0 

6 

39 

27 

0 

4 

1 

32 

148 

16 

9 

2 

0 

27 

169 

37 

6 

3 

2 

48 

205 

14 

24 

0 

0 

48 

187 

39 

27 

3 

4 

73 

214 

10 

0 

9 

0 

12 

86 

8 

1 

0 

0 

9 

195 

26 

1 

3 

2 

32 

138 

27 

124 

0 

8 

159 

243 

108 

270 

14 

26 

418 

286 

25 

/ 

2 

2 

36 

194 

22 

8 

0 

0 

30 

207 

29 

2 

1 

0 

38 

121 

56 

33 

7 

4 

100 

396 

9 

34 

2 

1 

46 

155 

4 

5 

0 

0 

9 

155 

6 

0 

1 

0 

7 

80 

28 

0 

3 

0 

31 

271 

6 

0 

1 

0 

t 

259 

30 

6 

4 

0 

40 

242 

10 

8 

4 

3 

90 

278 

7 

3 

2 

12 

100 

38 

13 

3 

1 

55 

166 

34 

0 

1 

1 

36 

235 

16 

13 

1 

2 

32 

132 

28 

22 

3 

2 

55 

217 

2.406 

1.679 

250 

164 

4,499 

108.1 

Per  cent 
of  Total 
Deaths 

13 
13 
13 
17 
17 
12 
14 
19 
21 
10 
12 
22 
18 

5 

5 
14 
14 
16 
11 
16 
11 
23 
13 
13 
12 
20 
14 
U 
26 
12 
13 

7 
24 
28 
20 
15 

9 
15 
20 
12 
18 


•Outside  City . 


Tuberculoffls,  All  Forms 

White 

Colored 

'As  per  Census  1910 


•Death  rate 

Number  per  100,000 

Deaths  Population 

2,656  155.2 

1,843         405.5 


TABLE  NO.  3 


Showing  the  Tuberculosis  death  rates  of  all  Registration  States  for  the  year  1913. 


California 202.2 

Colorado 185.9 

Conneeticut 140 , 5 

Indiana 149.7 

Kentuckj- 201.5 

Maine 126. 9 

Maryland... 194.5 

Maasachusette  _ 144.2 

Michigan ._  91.7 

Minnesota 107. 4 

Missouri _ .  143. 5 

Montana... 108.8 

Average  Death  Rate  All  Registration  States 

Death  Rate  of  Tennessee,  1915 

White 

C  olored 


New  Hampshire. 

New  Jersey 

New  York 

Ohio 

Pennsylvania 

Rhode  Island 

Utah 

Vermont 

Virginia 

Washington 

WiscoBsm 


120.2 
153.3 
167.1 
132.2 
120.9 
162.7 
48.9 
107.4 
168.7 
92.8 
97.8 

144.6 

198.1 

n55.2 

•405. 5 


There  are  two  States  with  a   tuberculosis  death  rate  above  that  of  Tennessee 
and  twenty-one  with  rates  below  Tennessee. 


Avwage  Death  Rate  of  the  Rural  Part  of  all  Registration  States. 

.A.verage  Death  Rate  of  the  Registration  Cities 

Rural  Part  of  Tennessee 

Cities  in  Tennessee 


*As  per  U.  S.  Census  1910. 


126.6 

165.5 
180.8 
240.9 


TYPHOID  FEVER 

The  reader  will  please  refer  to  Table  No.  4  and  compare  the  death  rate  of  his 
county  with  that  of  the  State,  and  with  the  rates  of  the  States  mentioned  in 
Table  No.  5. 

From  this  comparison  the  relationship  which  obtains  between  the  various  units 
mentioned  may  be  determined  with  regard  to  the  typhoid  problem. 

Only  21  of  the  typhoid  deaths  occurred  in  March,  1915,  whereas  135  occurred  in 
August.  The  reason  for  this  great  difference  is  that  the  fly  prevails  in  the  sum- 
mer and  fall  seasons.  It  cannot  be  doubted  therefore,  that  the  fly  is,  by  far  the 
most  important  agent  in  the  transmission  of  typhoid  fever. 

The  average  age  at  death  from  typhoid  fever  is  28  years.  A  large  majority  of 
the  persons  who  died  of  typhoid  fever  last  year  were  between  the  ages  of  20  and  40. 

Expert  epidemiologists  have  estimated  that  about  18  cases  of  typhoid  fever 
have  occurred  for  each  death  that  occurs  in  one  yea.T.  At  this  ratio  there  were 
16,308  cases  of  typhoid  in  Tennessee  last  year. 

The  mortality  rate  of  typhoid  fever  may  be  properly  interpreted  as  reflects  the 
sanitary  conditions  of  the  various  communities. 

TABLE  NO.  4.     TYPHOID  FEVER. 

Showing  the  number  of  deaths  from  typhoid  fever  in  each  county  in  the  State 
together  with  the  death  rate  of  each  per  100,000  population. 


Anderson.. 
Bedford... 

Benton 

Bledsoe... 

Blount 

Bradley... 
Campbell.. 

Cannon 

Carroll.... 

Carter 

Cheatham. 

Chester 

daibonie. 


hsDea 

ith  rate 

No.  Deaths  Death  Rate 

6 

33.9 

Clay. 

1 

10.7 

14 

61.9 

Cocke 

-. 7 

35.9 

12 

94.0 

Coffee.. 

9 

57.6 

4 

75.2 

Crockett 

8 

49.6 

lU 

46.3 

Cumberland 

2 

20.4 

4 

24.0 

•Davidson 

22 

46.3 

6 

18.7 

Decatur. 

8 

80.0 

8 

74.0 

DeKalb. 

15 

97.0 

15 

62.0 

Dickson 

9 

43.7 

8 

37.0 

Dyer... 

22 

74.0 

b 

46.7 

Fayette 

9 

29.6 

9 

99.0 

Fentress 

4 

49.3 

1 

4.0 

Franklin... 

34.1 

-8— 


No.  Deaths  Death  Rate 

Gibson -  22  51.4 

Giles. -.--  7  21.4 

Grainga- - 4  28.9 

Greene - 13  41.5 

Grundy -  0  00 

Hamblen. 7  49.5 

•Hamilton. 10  22.1 

Hancock 3  27.8 

Hardeman 6  26.0 

Hardin 2  11.4 

Hawkins. 7  29.6 

Haywood 15  57.2 

Henderson 13  76.4 

Henry 19  73.0 

Hickman 4  24.0 

Houston ! 5  80.0 

Himiphreys -  2  14.1 

Jackfisn 9  60.0 

James 2  38.4 

Jefferson 6  33.8 

Johnson 2  13.7 

•Knox 16  24.1 

Lake -  0  00 

Lauderdale 16  75.7 

Lawrence. 4  21.3 

Lewis 3  43.7 

Lincoln. 10  39.0 

Loudon 6  39.8 

Macon 9  58.4 

McMinn 12  54.5 

McNairy 3  18.4 

•Madison 13  56.0 

Marion 9  45.9 

Marhsal! 18  107.1 

Maurj' 11  27.2 

Meigs 1  16.3 

Monroe 10  45.8 

Montgomerj-. 31  92.2 

Moore 0  00. 

Morgan. 7  57.5 

Obion.... 16  51.9 

Overton 6  34.9 


No.  Deaths  Death  Rat« 

Perry 5  56.8 

Pickett - 1  20.6 

Polk 4  26.8 

Putnam 10  46.0 

Rhea... 5  31.4 

Roane.. 6  26.2 

RoberUon 13  50.7 

Rutherford 14  42.2 

Scott..... 2  14.3 

Sequatchie 0  00. 

Sevier... 7  31.2 

•Shelby 16  24.6 

Smith .-  2  10.8 

Stewart 16  108.1 

Sullivan.. 5  16.8 

Sumner 10  39.0 

Titpon.. 11  37.3 

Trousdale 3  51.7 

Unicoi 2  25.0 

Union 3  26.3 

Van  Buren 0  00. 

Warren 6  36.3 

Washington 9  28.3 

Wayne 5  41.6 

Weakley 15  47.0 

White 6  37.5 

Williamson 13  53.7 

Wilson _ -  11  43.4 

Total  Rural 784  41.3 

Nashville.. 43  37.1 

Chattanooga __ 12  20.5 

Knoxville.. 12  31.3 

Jackson. 9  51.1 

Memphis 46  31.4 

Total  City 122  32.4 

TotalState 906  39.8 


TABLE  NO.  5.    TYPHOID  FEVER. 

Showing  the  death  rate  of  the  registration  area  and  of  all  Pvegistration  States 

from  t3T)hoid  fever  for  the  year  1913. 

Death  Rate  per  Rural  City 
100,000  Pop.            Death  Rate  Death  Rate 

Entire  Registration  Area 17.9 

CanfMTlia      15.9  15.1  10.6 

Colorado 17.0  17.2  16.6 

Connecticut... -.--  11.3  7.8  12.9 

Indiana  25.0  23.6  28.2 

Kentucky      .             42.7  46.2  27.1 

Maine 12.0  10.4  17.3 

Maryland... 33.3  36.6  29.5 

Massachusetts 7.9  8.7  8.6 

Michigan 18.4  13.9  25.4 

Minnesota 10.8  9.1  14.1 

Missouri 24.4  25.7  22.3 

Montana 22.7  19.5  32.0 

New  Hampshire.... 11.2  11.8  12.1 

NewJersey 9.6  8.7  10.2 

NewYork -  10.3  11.8  9.9 

•North  Carolina 57.4  51.4  65.4 

Ohio -.-.  24.0  K.O  22.9 

Pennsylvania..   18.1  16.2     '  20.2 

Rhodelsland 8.3  7.3  8.5 

Utah 22.2  17.1  20.8 

Vermont - 7.8  8.3  4.3 

Virginia  ...              .  33.3  23.1  28.1 

Washington 10.3  12.1  7.8 

Wteoonsin 9.0  5.7  15.  .=i 

•In  incorporate  towns  of  over  1,000  population. 

—9— 


DIARRHEA  AND  ENTERITIS  OF  INFANTS 
UNDER  2  YEARS  OF  AGE 

Insanitary  conditions  and  improper  diet  are  the  two  important  factors  which 
have  contributed  to  the  mortality  from  this  cause. 

The  deaths  of  many  other  children  over  2  years  of  age  occurred,  but  they  are 
not  tabulated  for  the  reason  the  standard  of  2  years  had  to  be  adhered  to  in  order 
to  enable  an  accurate  comparison  of  the  death  rate  of  Tennessee  with  those  of 
other  States. 

TABLE  NO.  6. 
Diarrhea  and  Enteritis  of  Infants  Under  2  Years  of  Age. 

Showing  the  number  of  deaths  in  each  county  and  city  together  with  the  death 
rate  of  each  per  100,000  population. 


No.  deaths  Death  rate 

11  62.1 

11  48.6 

1  7.9 

0 

12 

9 

4 


Anderson. -- 

Bedford 

Benton 

Bledsoe 

Blount 

Bradley 

Campbell- -- 

Cannon 

Carroll 

Carter 

Cheatham.. 

Chester 

Claiborne  _ . 

Clay 

Cocke 

Coffee 

Crockett 

Cmnberland 
*Da\'idson.- 

Decatm' 

DeKalb_... 

Dickson 

Dyer 

Fayette 19 

Franklin 

Gibson 

Giles .- 

Grainger... 

Greene 

Grundy  . . . 
Hamblen... 
'Hamilton.. 
Hancock  .. 
Hardeman.. 

Hardin 

Hawkins 

Haywood-. 
Henderson. 

Henry 

Hickman... 
Houstoa... 
Humphreys 

Jackson 

James 

Jefferson... 

Johnson 

*Knoi 

Lake 

Lauderdale. 
Lawrence. - 

Lewis , 

Lincoln 

Loudon 


00. 

55.6 

54.0 

12.2 

54.1 

41.8 

100. 9 
84.1 
33.0 
56.2 
21.5 
66.6 
64.1 
74.9 
00. 
88.2 
9.9 
6.4 
19.4 
53.6 
29.4 
36.8 
48.6 
67.6 
36.8 
72.0 
51.4 
23.3 
77.7 

145.8 
37.1 
21.7 
39.9 
00. 
95.2 
52.8 
34.5 
18.1 
00. 
21.2 
13.3 
19.2 
22.5 
20.6 
28.6 
10.6 
33.2 
26.7 
43.7 
26.9 
46.4 


Macon 

McMinn 

McNairy 

•Madison 

Marion 

Marshall 

Maury 

Meigs 

Monroe 

Montgomery- 
Moore 

Morgan 

Obion 

Overton 

Perry 

Pickett 

Polk 

Putnam 

Rhea 

Roane 

Robertson 

Rutherford.. 

Scott 

Sequatchie... 

Sevier 

•Shelby 

Smith 

Stewart 

Sullivan 

Sumner 

Tipton 

Trousdale 

Unicoi - 

Union 

Van  Buren.- 

Wanen 

Washington-. 

Wayne 

Weakley 

WTiite - 

Williamson.. 
Wilson 


No.  Deaths   Death 
3 


2 
4 
5 
9 
1 

11 

11 
1 
5 

16 
6 
1 
2 
7 
8 
7 

18 
4 
7 
4 
1 
7 

37 
5 
5 

10 
9 

15 
2 
3 
1 
0 
5 
9 
5 

14 

10 


Total  Rural 817 

Nashville - 112 

Chattanooga 35 

KnoxviUe 22 

Jackson 10 

Memphis HI 

Total  City 290 

Grand  total 1,107 

•Outside  the  City. 


Rate 
19.4 
49.8 
36.8 

8.6 
20.4 
29.7 
20.2 
16.3 
50.4 
32.7 
20.8 
40.3 
51.9 
34.9 
11.3 
40.0 
44.1 
36.4 
44.0 
78.6 
15.6 
21.1 
28.7 
21.7 
31.2 
56.6 
27.0 
33.8 
33.8 
35.1 
50.8 
34.4 
37.9 

8.7 
00. 
30.0 
27.8 
41.6 
43.9 
62.5 
24.7 
31.5 


96.3 
59.7 
57.4 
56.8 
75.7 


48.2 


—10— 


PELLAGRA 

As  will  be  noted  in  Table  Xo.  7  there  occurred  839  deaths  from  pellagra  in  Ten- 
nessee in  1915.  Only  11  of  the  ninety-six  counties  failed  to  have  a  death  from 
pellagra,  which  indicates  that  the  disease  is  well  distributed  over  the  State.  Hard- 
eman county  shows  the  highest  death  rate  of  any  of  the  counties.  This  is  prob- 
ably explained  by  the  fact  that  the  West  Tennessee  Hospital  for  the  Insane  is 
located  in  this  county. 

But  few  of  the  States  in  the  registration  area  have  a  verj-  high  death  rate  from 
pellagra;  in  fact,  only  1,015  deaths  occurred  in  the  entire  registration  area  in  1913> 
and  a  large  number  of  these  occurred  in  southern  cities  and  in  a  few  southern  States. 

The  Registration  States  with  the  greatest  number  of  deaths  in  1913  were  as 
follows:  Xorth  Carolina  (in  municipalities  of  over  1,000  population)  157,  Kentucky 
10-1,  Virginia  165. 

Tennessee  had  644  deaths  in  1914  and  839  in  1915,  an  increase  of  31.6  per  cent. 
It  is  difficult  to  determine  as  to  whether  or  not  the  increase  is  actual  or  apparent. 

The  question  as  to  whether  or  not  the  disease  actually  increased  as  rapidh'  as 
indicated  above  might  be  raised  on  the  ground  that  the  disease  is  always  recog- 
nized now,  whereas  it  was  not  always  recognized  in  the  past,  but  we  are  unable 
to  determine  as  to  whether  or  not  this  is  true,  or  the  extent  it  would  affect  the  death 
rate  if  it  were  true. 

INTERPRETATION 

By  reason  of  the  fact  that  the  exact  cause  of  the  disease  is  not  known  we  are  not 
in  position  to  interpret  our  mortalitj'  statistics. 

Accepting  as  true  the  recent  announcements  of  Dr.  Jos.  Goldberger  of  the  U.  S. 
Public  Health  Ser\-ice,  we  would  be  justified  in  sa}-ing  that  our  mortality  rate 
indicates  that  a  large  number  of  people  are  eating  an  unbalanced  diet,  composed 
of  a  disproportionately-  large  amount  of  carbohydrate  elements,  such  as  bread, 
potatoes  and  sw^eets,  and  disproportionately  small  amount  of  proteid  elements, 
such  as  eggs,  meat,  milk  and  legimies. 

Again  one  could  not  say  definitely  as  to  whether  an  unbalanced  diet  is  eaten 
on  account  of  inability  to  procure  the  necessarj'  elements  for  a  balanced  diet,  or 
on  account  of  an  eccentricity  in  diet. 

The  disease  occurrs  chiefly  among  the  poorer  classes.  This  observation  is  made 
in  every  country  in  which  the  disease  occurs. 

The  proteid  elements  of  diet  are  the  most  costly  elements.  The  price  of  a  dozen 
eggs  will  buy  enough  meal  to  last  a  family  much  longer  than  the  eggs  would  last. 

We  are  in  position  to  say  definitely  that  a  faulty  diet  is  the  only  influence  svhich 
we  know  to  be  a  factor  in  producing  the  disease,  and  that  a  good,  well-balanced 
(jjet  is  the  only  agent  we  know  to  be  of  value  in  curing  the  disease. 

Under  present  conditions  then  the  disease  is  not  susceptible  of  executive  control. 
The  people  in  the  community  in  which  the  disease  prevails  may  take  the  step  which 
will  lead  to  a  reduction  in  the  mortality  rate  of  the  disease  if  they  feel  disposed, 
by  correcting  the  faults  above  referred  to. 

—11— 


TABLE  NO.  7.     PELLAGRA. 


Showing  the  number  of  deaths  from  pellagra  in  each  county  together  with  the 
death  rate  of  each  per  100,000  population,  for  the  year  1915. 


Number      Rate  per 
Counties  Deaths       lOO.OUO 

Anderson 14  77.9 

Bedford-. - - 3  13.2 

Benton 1  7.8 

Bledsoe 2  37.7 

Blount 5  23.1 

Bradley 7  42.1 

Campbell 5  15.3 

Camion 2  18.5 

Carroll 3  12.5 

Carter. ---  4  18.6 

Cheatham.. 4  37.4 

Chester 2  22.2 

Claiborne 1  4.0 

Clay 0  00. 

Cocke 2  10.2 

CoSEee.. 1  6.4 

Crockett .- 3  18.6 

Cuiriberland 0  00. 

Davidson  (outside) 29  61.0 

Decatur 2  20.0 

DeKalb .-  1  6-5 

Dickson 5  24.2 

Dyer 4  13.4 

Fayette 18  65.5 

Fentress 0  00. 

Franklin *>  14-6 

Gibson 13  30.3 

Giles 6  18.6 

e=^::::::::::::::::::::  ^ 

Grundy 3  oo.a 

Hamblen...... 13  92.2 

Hamilton  (outside) 2<  59./ 

Hancock 1  „„?„ 

Hardeman 48  208.6 

Hardin 0  00. 

Hawkins.. 2  8.6 

Haywood -  19  72.1 

Henderson 1  ^-^ 

Henry -  4  15.3 

Hickman 3  18.0 

Houston 4  64.5 

Humphreys 1  ^.0 

Jackson. - 0  00.0 

James 2  d8.4 

Jefferson 2  11.3 

Johnson... -  0  00. 

Knox  (outside 42  63.3 

Lake.. 0  00. 

Lauderdale 6  28.4 

Lawrence --  4  il.-i 

Lewis 2  M.i 

Lincoln 6  23.0 

Ix.udon —  3  20.0 


No .  Deaths   Death  Rate 

Macon... , 1  6.5 

McMinn 16  72.7 

McNairy _. 4  24.5 

Madison  (outside) 7  30.1 

Marion .-  8  40.8 

Marshall 0  00. 

Maury ..-  14  33.1 

Meigs 0  00. 

Monroe - -  1  4.5 

Montgomery 13  38.6 

Moore «  00. 

Morgan 2  16.1 

Obion.. 5  16.2 

Overton 1  5.8 

Perry 1  113 

Pickett -  0  00. 

Polk .--  3  19.3 

Putnam 2  9.2 

Rhea 11  69.0 

Roane. H  48.0 

Robertson.. 6  23.4 

Rutherford .--  0  00. 

Scott 2  14.4 

Sequatchie 0  00. 

Sevier 1             4.4 

Shelby  (outside) S>4  143.9 

Smith 1             5.4 

Stewart 1             6.7 

Sullivan 2             6./ 

Sumner 3  11.7 

Tipton 11  37.2 

Trousdale 1  17.2 

Unicoi .-  1  12.6 

Union 1  J-7 

VanBuren 0  00. 

Warren 6  30.3 

Washiagton 7  21.6 

Wayne 2  16.6 

Weakley 2             6.2 

White 6  37.5 

Williamson 3  12.4 

Wilson.. 9  35.5 

Nashville 34  29.3 

Chattanooga 52  88.8 

Knoxville 34  88.9 

Jackson 8  4o.8 

Memphis HO  '6.8 

Total 839  36.7 

White-.-. 469  '27.4 

Colored 370  '78.2 

•As  per  census  of  1910. 


—12— 


MALARIA 

In  the  table  herewith  presented  mil  be  found  the  number  of  deaths  from  malaria 
in  each  county  and  city  in  the  State,  together  mth  the  death  rate  of  each  from  this 
cause  for  the  year  1915. 

This  disease  is  not  so  extensively  distributed  as  other  diseases.  It  prevails 
chiefly  in  one  grand  division  of  the  State. 

One  cannot  accurately  determine  the  number  of  cases  of  malaria  that  occurred 
last  year,  because  this  disease  is  not  so  fatal  as  many  others;  in  fact,  it  has  no 
definite  mortality  rate.  It  has  been  estimated,  however,  that  at  least  300  cases 
of  the  disease  have  occurred  in  one  year  for  every  death  that  occurs  in  this  time. 
This  is  one  of  the  most  conservative  of  the  many  morbidity  estimates  made.  At 
this  rate  there  were  149,100  cases  of  malaria  in  Tennessee  last  year.  The  enormity 
of  the  amount  of  sickness  from  this  cause  in  one  year  is  therefore  apparent.  Some 
of  the  cases,  of  course,  were  more  or  less  chronic;  some  were  acute,  and  the  amount 
of  time  lost  by  bread  winners  from  gainful  occupations  cannot  be  determined. 

The  financial  loss  which  each  community  suffers  in  one  particular  may,  however , 
be  approximately  estimated.  Fertile  lands  in  a  malarial  section  will  not  sell  for 
more  than  ten  to  twenty-five  per  cent  of  the  price  less  fertile  lands  bring  in  a  non- 
malarial  section. 

The  scientific  questions  involved  in  the  prevention  of  malaria  have  been  worked 
out  probably  more  definitely  than  those  of  an}'  other  preventable  disease,  and  the 
prevention  of  the  disease  can  be  accomplished  probably  as  cheaply  as  any  other. 
Its  prevention,  however,  cannot  be  made  so  much  an  individual  matter.  It  may 
be  said  that  the  prevention  of  malaria  will  be  accomplished  only  by  a  concerted 
community  effort. 

SCIENTIFIC  CONSIDERATION 

The  fundamental  scientific  facts  upon  which  rests  the  structure  of  malaria  pre- 
vention are  these: 

1.  Malaria  is  caused  by  a  germ — the  Plasmodium  malariae. 

2.  This  germ  is  transmitted  from  person  to  person  by  one  species  of  mosquitoes. 

3.  The  germ  remains  alive  in  the  blood  of  a  person  who  has  had  an  attack  of 
the  disease  for  years,  provided  treatment  is  not  properly  administered,  or  not  con- 
tinued a  sufficient  length  of  time.  These  are  called  "malaria  carriers,"  and  con- 
stitute a  constant  source  of  infection. 

From  these  statements  of  facts  we  may  arrive  at  three  conclusions  with  respect 
to  the  prevention  of  malaria.  We  may  conclude:  First,  that  if  there  were  no 
mosquitoes  of  a  certain  type  malaria  would  cease  to  occur;  second,  if  there  were  no 
malaria  carriers  there  would  be  no  source  from  which  a  mosquito  could  get  the 
germ,  and  therefore  the  disease  would  cease  to  occur;  third,  if  a  well  person  could 
prevent  an  infected  mosquito  from  getting  access  to  him  the  disease  would  cease 
to  occur.  These  conclusions  suggest  three  lines  of  procedure  in  preventing  the 
disease: 

—13— 


1.  That  of  mosquito  eradication. 

2.  That  of  properly  treating  all  malaria  carriers. 

3.  That  of  screening  the  house  so  as  to  prevent  the  access  of  mosquitoes. 

Experience  has  taught  that  either  of  these  lines  of  procedure  may  be  pursued 
with  pronl,  but  that  the  best  results  Nnll  follow  the  adoption  of  all  three  of  them- 

DESTRUCTION  OF  MOSQUITOES 

The  destruction  of  the  mosquito  is  accomplished  by  draining  or  treating  stag- 
nant ponds  of  water  of  certain  types.  Fish  and  ducks  may  be  employed  to  some 
advantage  when  neither  of  the  other  two  methods  are  practicable. 

The  treatment  of  a  carrier  should  be  administered  by  a  physician.  It  can  be 
carried  out  in  winter,  or  in  summer,  and  should  be  done  in  coimection  with  bac- 
teriologic  work,  in  order  that  carriers  may  be  diagnosed  and  their  cure  determined 
by  this  means. 

Screening  should  be  a  2S-mesh,  and  should  be  well  done,  and  they  should  be 
kept  closed. 

One  need  only  mention  that  the  canal  zone  has  a  relatively  small  amount  of 
malaria  now  as  compared  with  previous  years  to  convince  the  most  skeptical 
that  money  properly  spent  in  the  prevention  of  malaria  will  accomplish  gratifying 
results. 

TABLE  NO.  8.     MALARIA. 

Showing  the  number  of  deaths  in  each  county  and  city,  together  with  the  death 
rate  of  each. 


Death  rate 
No.  deaths  per  100,00 

Anderson _ 0  00. 

Bedford 0  00. 

Benton 7  55.1 

Bledsoe 0  00. 

Blount...- 0  00. 

Bradley 0  00. 

Campbell 0  00. 

Cannon 0  00. 

Carroll 11  40.0 

Carter 0  00. 

Cheatham 5  40.7 

Chester 3  33.3 

Claibome 0  00. 

Clay 3  32.2 

Cocke 0  00. 

Coffee 1  6.4 

Croekett 6  37.2 

Cimiberland 0  00. 

'Davidson 0  00. 

Decatur 0  00. 

DeKalb 0  00. 

Dickson 2  9.7 

Dyer 16  53.6 

Fayette 16  62.2 

Fentress... 0  00. 

Franklin 6  29.2 

Gibson 19  44.3 

GUes... 8  24.3 

Grainger 0  00. 

Greene... 0  00. 

—14- 


Ko.  Deaths  Death  Rate 

Grundy 0  00. 

Hamblen 0  00. 

*Hamilton 5  11.0 

Hancock 0  60. 

Hardeman 6  26.0 

Hardin 6  34.2 

Hawkins 0  00. 

HajTTOod 16  61.0 

Henderson 7  41.1 

Henry 7  26.9 

Hickinan 1  6.0 

Houston 0  00. 

Humphreys 4  28.3 

Jackson 0  00. 

James 1  19.2 

Jefferson 1  5.6 

*Knox 0  00. 

Lake 6  63.9 

Lauderdale 23  109.0 

Lawrence 0  00. 

Lewis 0  00. 

Lincoln 0  00. 

Loudon 0  00. 

Macon 0  00. 

McMinn 1  4.5 

McNairj- 7  42.9 

•Madison. 19  82.3 

Marion 2  10.2 

Marshall 3  17.8 

Maury 1  2.4 

Meigs 0  00. 


No.  Deaths  Death  Rate 

Monroe 1  4.5 

Montgomery 2  5.9 

Moore 0  00. 

Morgan 0  00. 

Obion 15  48.7 

Overton 0  00. 

Peny ..-..  6  68.1 

Pickett- 0  00. 

Polk 0  00. 

Putnam 0  00. 

Ehea 0  00. 

Roane 0  00. 

Robertson 1  3.9 

Rutherford 1  3.0 

Scott.-. --• 0  00. 

Sequatchie 0  00. 

Sevier 0  00. 

•Shelby 66  101.0 

Smith 1  5.4 

Stewart 5  33.7 

SulKvan 0  00. 

Sumner 0  00. 


No.  Deaths  Death  Rate 

Tipton 40  135.5 

Trousdale 1  17.2 

Unicoi.-- 0  00. 

Union 0  00. 

VanBuren.. 0  00. 

Warren 0  00. 

Washington 0  00. 

Wayne 3  24.8 

Weaklev 5  15.6 

White.;.- 6  37.5 

Williamson 1  4.1 

Wilson 0  00. 

Nashville 5  4.3 

Chattanooga 0  00. 

Knoxville 0  00. 

Jackson 10  56.8 

Memphis 106  72.5 

Grand  Total 497  21.6 

'Outside  city. 


—15— 


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